Oral Infections



Oral Infections 2337
Photo by: Mihai Simonia

Oral infections are infections that occur in or around the mouth.

What Are Oral Infections?

Bacteria and viruses usually cause oral infections. They can affect the teeth, gums, palate (PAL-it, the roof of the mouth), tongue, lips, and inside of the cheeks. Simple oral infections are limited to the mouth and are different from oral lesions * , which are non-infectious and may be a sign of an illness that involves other parts of the body.

Oral infections are very common. Tooth decay is the second most common infectious condition, after the common cold.

* lesions (LEE-zhuns) is a general term referring to sores or damaged or irregular areas of tissue,

Many oral infections are not contagious because bacteria that exist naturally in every person's mouth cause them. However, herpangina (her-pan-JY-na) and recurrent herpes labialis (HER-peez lay-be-AL-us) are contagious and spread through contact with fluid from an infected person's mouth and nose.

KEYWORDS

for searching the Internet and other reference sources

Aphthous ulcer

Candidiasis

Canker sore

Cavity

Cold sore

Dental caries

Gingivitis

Gingivostomotitis

Gum disease

Herpangina

Herpes labialis

Periodontal disease

Thrush

Tooth care

Tooth decay

What Are Some Common Oral Infections?

Canker sores

Canker sores, also called aphthous (AF-thus) ulcers, are painful but benign * sores that occur on the tongue, inside of the lips and cheeks, gums, and palate. There is no evidence that canker sores are caused by an infectious organism. However, they are very common and can be confused with the sores that appear with some mouth infections. The ulcers may appear one at a time or in groups. They are small, pale, shallow, gray-white, and usually surrounded by bright red tissue.

These sores most frequently affect children and young adults. Sometimes they erupt when people accidentally bite the inside of their mouth or where braces rub the inside of the cheek. Stress, sensitivity to a particular food, not getting enough iron or B vitamins, and changes in hormones * , like those that occur during women's normal menstrual cycles, also may trigger canker sores. Often there is no apparent reason why a person develops a canker sore, although some people may be more likely to have them, especially if other people in their family have had canker sores. It previously was thought that canker sores were the result of an infection, but no infectious agent has been found. Now it is believed that something triggers the immune system, and the cells that normally fight infection "attack" the body's own tissue, leading to a canker sore.

Someone who has a canker sore may feel a tingling or burning sensation before a sore, reddish spot appears. The pain from a canker sore lasts up to 10 days, and the sore heals completely in 1 to 3 weeks. Canker sores usually come and go throughout a person's life. Occasionally, a person who develops a severe outbreak of canker sores may have a fever or a generally ill feeling.

A doctor (or dentist) usually diagnoses canker sores simply by examining the sore. Rarely, a biopsy * may be taken if the sore is unusually large or is not healing as expected, to distinguish it from other types of mouth ulcers. These sores heal without treatment, but over-the-counter medicines for canker sores can ease pain. People with more serious sores may be prescribed medication to apply to them. Experts advise anyone with a canker sore to avoid acidic, hot, or spicy foods and to rinse the mouth and gargle with warm saltwater to relieve pain. There is no known way to prevent the sores.

* benign (beh-NINE) means a condition is not cancerous.

* hormones are chemical substances that are produced by various glands and sent into the bloodstream carrying messages that have certain effects on other parts of the body.

* biopsy (BI-op-see) is a test in which a small sample of skin or other body tissue is removed and examined for signs of disease.

Cavities

Dental caries (KARE-eez), also known as tooth decay and cavities, are areas where the hard enamel of a tooth has been destroyed, leaving small holes that are susceptible to further decay. Tooth decay occurs most frequently in children and teens and is the leading cause of tooth loss in younger people. Up to 80 percent of teens have had cavities by the time they finish high school, although tooth decay is much less common today than it was before fluoride supplements and regular dental care were available to most people.

Bacteria that live in the mouth, especially certain kinds of streptococcus (strep-tuh-KAH-kus), cause tooth decay. The bacteria change food, particularly sweet and starchy foods, into acid, which eats away at the enamel of teeth. The acid, bacteria, and bits of food in the mouth combine into a thin film known as plaque (PLAK), which coats the teeth and collects in their grooves. A person with dental caries may experience pain or sensitivity in the affected tooth, usually when eating cold, hot, or sweet foods. Some people may not feel anything at all until the cavity extends into the middle part of the tooth, which houses the tooth's blood vessels and nerves. If left untreated, caries can lead to long-term tooth sensitivity, abscesses * , weakened teeth that can break easily, and even tooth loss.

Sugary foods and drinks and other foods contain carbohydrates * that increase the risk of tooth decay. Frequent meals and snacks also give the bacteria more chances to produce acid. Infants and young children who sip milk or juice throughout the day or go to bed with a bottle may develop bottle caries, a pattern of tooth decay that can damage baby teeth extensively.

Tooth decay usually is diagnosed during regular dental visits, and, depending on how badly the tooth has decayed, it may be treated with a filling, crown, or root canal (surgery to remove the pulp of the tooth). A dentist can apply a protective sealant to the molars or use fluoride to help prevent caries. Limiting sweets and frequent snacks; good dental hygiene (brushing and flossing); getting fluoride from drinking water, toothpaste, or other supplements; and regular dental visits are the best ways to prevent tooth decay.

Gingivitis

Gingivitis (jin-juh-VY-tis) is inflammation of the gums, also known as the gingiva. It is caused by plaque that coats the teeth along the gum line. The bacteria and acid inflame and irritate the gums, making them red, swollen, and tender. If the plaque is not removed by brushing, flossing, and regular dental visits, it hardens into tartar at the base of the teeth and at the gum line, which further irritates the gums. As gingivitis progresses, the buildup of plaque and tartar causes the gums to recede and affects the ligaments * and bones supporting the teeth. Gingivitis often appears during puberty or early adulthood, and it is the first stage of periodontal * disease.

* abscesses (AB-seh-sez) are localized or walled off accumulatlons of pus caused by infection that can occur anywhere within the body.

* carbohydrates are nutrients in food that help provide energy to the body.

* ligaments are bands of fibrous tissue that connect bones or cartilage, supporting and strengthening the joints. Ligaments in the mouth hold the roots of teeth in the tooth sockets.

* periodontal (pare-e-o-DON-tul) means located around a tooth.

Some causes of gum irritation, which can lead to gingivitis, include:

  • poor dental care and habits
  • dental devices or appliances (such as bridges or braces) that have rough, irritating edges
  • extremely vigorous tooth brushing or flossing
  • teeth that are not aligned properly
  • pregnancy
  • poorly controlled diabetes * or certain other long-lasting illnesses

Swollen, bright red, tender gums that bleed easily and mouth sores are signs of gingivitis. It is diagnosed by examining the gums during a dental visit, and dental X rays may be taken to determine how much damage has been done to underlying structures in the mouth. People with gingivitis are treated with a thorough dental cleaning, followed by careful and regular at-home cleaning of the teeth and gums. Antibacterial mouthwash also may be prescribed. Gingivitis will not clear up on its own and can progress to serious periodontal disease that eventually affects the ligaments that hold the teeth in the gums and the tooth sockets, leading to tooth loss. Untreated gingivitis also may cause abscesses or a condition known as trench mouth, which is a severe and painful form of gum disease.

Herpangina

Herpangina is an infection marked by painful sores on the roof of the mouth, the tonsils * , and sometimes the inside of the cheeks. The lesions start as small bumps but become whitish sores with a red border. Herpangina usually is caused by coxsackievirus (kok-SAHkee-vy-rus), which also causes hand, foot, and mouth disease; in hand, foot, and mouth disease, small blisters are found on the palms and the soles as well as the mouth. A day or two before the sores of herpangina appear, a person may have a fever, sore throat, and headache. Symptoms last less than a week.

Herpangina tends to affect young children and occurs most frequently in summer and fall. Like many other infections from common viruses, it is difficult to prevent. A doctor diagnoses herpangina by examining the appearance and location of the patient's lesions. Treatment includes drinking enough fluid and using over-the-counter medication such as acetaminophen (uh-see-teh-MIH-noh-fen) for pain and fever relief. A person also may apply numbing cream to the lesions to ease discomfort.

Gingivostomatitis

Gingivostomatitis (jin-juh-vo-sto-muh-TY-tis) is an infection of the gums and mouth caused by herpes simplex virus type 1 (genital * herpes is caused by herpes simplex virus type 2) and other common childhood viruses. As with herpangina, fever and illness appear before the mouth sores do. The lesions begin as blisters that pop soon after they form, leaving the base of the blister. When this covering peels off, a tender ulcer is formed. It will look grayish or yellowish with a red border. These painful sores often make it difficult to eat.

* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough Insulin or the body cannot use the Insulin it makes effectively, resulting in increased levels of sugar in the blood. This can lead to increased urination, dehydration, weight loss, weakness, and a number of other symptoms and complications related to chemical imbalances within the body.

* tonsils are paired clusters of lymph tissues in the throat that help protect the body from bacteria and viruses that enter through a person's nose or mouth.

* genital (JEN-nih-tul) refers to the external sexual organs.

* cultures (KUL-churs) are tests in which a sample of fluid or tissue from the body is placed in a dish containing material that supports the growth of certain organisms. Typically, within days the organisms will grow and can be identified.

The diagnosis of gingivostomatitis is based on the presence of mouth sores, usually accompanied by other symptoms of a viral illness. Gingivostomatitis caused by herpes virus has a distinctive appearance and usually does not require more tests. Cultures * or biopsies rarely are done. Treatment for gingivostomatitis includes easing pain and preventing dehydration * . Over-the-counter pain medicine, medicated mouthwash or saltwater gargles, or numbing cream may provide some relief. Brushing teeth and gums gently will help prevent bacterial infection of the sores. Fluids and a bland diet are recommended as well.

Herpes

Recurrent herpes labialis, also known as cold sores or fever blisters, is a condition caused by herpes simplex virus type 1. Cold sores are extremely common. Most Americans are infected with the virus by age 20. The virus stays in the body for life, although it usually causes no disease or only an occasional cold sore in most people. Many things can trigger a reactivation of the herpes virus to cause recurrent cold sores, such as fever, sun exposure, and stress.

Burning, tingling, or itching may occur a day or two before a small, sometimes painful blister appears on the gums, lips, inside of the mouth, or around the mouth. The blister is filled with clear or yellowish fluid. Shortly after it forms, the sore crusts over, and the crust eventually falls off. Sometimes a person also develops a mild fever or feels ill.

A doctor diagnoses herpes labialis based on the appearance of the cold sores, although fluid from a blister may be examined or cultured to confirm the diagnosis. Patients with cold sores often report having had them before. The blisters usually disappear on their own after 1 to 2 weeks, but if a person has frequent or severe cold sores, a doctor may prescribe antiviral medication to shorten the outbreak. However, the medicine does not get rid of the virus. When cold sores appear, ice or warm compresses may ease any discomfort or pain.

Cold sores are contagious. Kissing spreads the virus by direct contact, but the virus may spread indirectly by sharing food, drinks, lipstick, or utensils. It is difficult to prevent this infection because it can spread when no sores are visible.

Thrush

Thrush, or candidiasis (kan-dih-DYE-uh-sis), is an overgrowth of Candida, a yeast-like fungus that can thrive in moist areas around body openings such as the mouth. Candidiasis can cause cracks in the corners of the mouth, and the lips, tongue, palate, and inside of the cheeks can have crusty whitish or yellowish patches. Candida also can cause other conditions, such as diaper rash and vaginal * yeast infections.

Thrush generally is not contagious, but newborns may come in contact with the fungus during birth if the mother has a vaginal yeast infection. People with weakened immune systems, such as those with AIDS * or cancer, may be more susceptible to thrush.

* dehydration (dee-hi-DRAY-shun) is a condition in which the body is depleted of water, usually caused by excessive and unreplaced loss of body fluids, such as through sweating, vomiting, or diarrhea.

* vaginal (VAH-jih-nul) refers to the vagina, the canal in a woman that leads from the uterus to the outside of the body.

* AIDS, or acquired immunodeficiency (ih-myoo-no-dih-FIH-shen-see) syndrome, is an infection that severely weakens the immune system; it is caused by the human immunodeficiency virus (HIV).

How Can People Prevent Oral Infections?

Frequent hand washing and avoiding exposure to people who are sick whenever possible helps prevent the spread of viral infections. Taking care of the teeth and mouth also goes a long way toward preventing oral infections. Tips for good oral hygiene include:

  • Visiting a dentist regularly (every 6 months) for teeth cleanings and check-ups, and brushing teeth twice daily. Fluoride toothpaste is recommended for children; anti-tartar toothpaste is recommended for adults.
  • Brushing the gums and tongue gently.
  • Flossing daily.
  • Brushing teeth after eating sugary or starchy foods.
  • Wearing a helmet, and possibly a mouth guard, when playing certain sports, such as football or hockey, to protect teeth from injury.
  • Not using tobacco products.

Resources

Organizations

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC's Division of Oral Health offers information about children's and adults' oral health at its website.
Telephone 800-311-3435
http://www.cdc.gov/OralHealth/index.htm

U.S. National Institute of Dental and Craniofacial Research, 45 Center Drive, MSC 6400, Bethesda, MD 20892. The National Institutes of Health's National Institute of Dental and Craniofacial Research provides information about oral and dental health at its website. Telephone 301-496-4261 http://www.nidcr.nih.gov



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